=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679457766
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIANNE YARADIKZA DIAZ QUINONES PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2025
-----------------------------------------------------
Last Update Date | 08/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 RIVER PLACE DR UNIT 444
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30909-0061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-346-0704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 RIVER PLACE DR UNIT 444
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30909-0061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-346-0704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH035635
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------